The project proposed is a medical guide to the health care of internationally adopted children. The multi-authored text includes specific comments addressed to each group in the audience: physicians and nurses, agencies and social workers, adoptive families and researchers. The contributors include physicians, nurses, social workers, dentists and therapists, many of whom are adoptive parents. All are nationally recognized experts in adoption research or in managing the health care needs of these children. Approximately 10,000 foreign-born children are adopted by U.S. citizens each year. Frequently abandoned, usually with minimal or no medical care, these children arrive into families of every imaginable background. Intent on the process of parenting, families are both unprepared for and shocked by the extent of the child's medical condition. Parasites, malaria, severe malnutrition, hepatitis B and other conditions loom as exotic and threatening diseases. Frequently, the family finds its own physician equally uninformed and alarmed. Despite recent increased medical interest in the health problems of internationally adopted children, there is no comprehensive practical resource for parents, social workers, adoption agencies or health care workers. Recommendations by the American Academy of Pediatrics consist of a 2-page summary published in 1973 and updated with another 2 pages In 1981. Scattered discussions of specific issues, such as tuberculosis, exist in both the medical and popular literature but are not easily accessible. The proposed book will collate and critically review the information currently available and identity areas requiring further research. Based on this and the experience of the three U.S. International Adoption Clinics, we will develop a practical guide to the efficient, thorough and cost-effective health care of such children and their families. The guide is intended as a resource for prospective parents, U.S. and foreign adoption agencies, social workers, physicians, nurses and clinics. The intent is to provide families and physicians with practical methods to deal with the 'routine' unusual diseases and conditions of the internationally adopted child (such as malaria). In addition, we will describe the state of knowledge In areas of uncertainty (such as intellectual outcome following severe malnutrition).